Radiographic Procedures III (RAD 228)

Transcription

1 Radiographic Procedures III (RAD 228) Urinary System RADIOGRAPHIC EXAMINATIONS Urinary System Antegrade Exam IVU Functional test Hypertensive evaluation as per protocol Retrograde Exams Retrograde Urography Non-functional test (OR Suite) Retrograde Cystography Non-functional test Voiding Cystourethrography Functional test Urinary System Kidneys (2) Ureters (2) Urinary bladder Urethra Anterior view 3 1

2 Urinary System Retroperitoneal structures Kidneys and ureters Infraperitoneal structures Distal ureters Urinary bladder Urethra Lateral view 4 Kidney Location Halfway between xiphoid process and iliac crest Between T11-T12 and L3 Nephroptosis 7 IVU Demonstrating Kidneys, Ureters, and Bladder 10 2

3 Equipment/Non-Ionic Contrast Check expiration date 13 Technologist Responsibilities 1. Patient history Clinical complaints? Food or drug allergies? Previous contrast media reaction? Asthma, hay fever, or hives? 20 Patient History Management of non insulin-dependent diabetes: Glucophage (metformin hydrochloride) Check chart and/or ask patient the following: Are you currently taking glucophage or other medication for diabetes mellitus? To be withheld 48 hours following iodinated contrast media procedure Must verify normal kidney function before resuming medication 21 3

4 Patient History Check blood chemistry normal ranges Creatinine level (adult) mg/dl BUN levels (adult) 8-25 mg/100 ml 22 Premedication Protocol Common protocol: Prescribed combination of Benadryl and prednisone over period of 12 or more hours before procedure Patients who have history of hay fever, asthma, food allergies, or previous contrast media reaction may be candidates for premedication procedure 25 Side Effect versus Reaction Side effects: expected outcome of injected contrast media Common side effects Temporary hot flash Metallic taste in mouth Reaction: An unexpected outcome of injected contrast media 26 4

5 Local Categories of Contrast Media Reactions Reactions that affect only a specific region of the body Systemic Reactions that affect the entire body or a specific organ system 27 Local Reactions Extravasation Leakage of iodinated contrast media outside the vessel and into surrounding soft tissues (also referred to as infiltration) May be toxic to skin Notify department nurse and/or physician Elevate affected extremity above heart Cold compress followed by warm compresses first to relieve pain and then to improve resorption 28 Local Reactions Phlebitis Inflammation of a vein Signs include pain, redness, and possibly swelling surrounding the venous access site Discontinue the venous access at this site Notify department nurse and/or physician 29 5

6 Systemic Reactions Mild Nonallergic reaction does not typically require drug intervention or medical assistance Symptoms include the following: Anxiety Light-headedness Nausea Vomiting Metallic taste (common side effect) Mild erythema Warm, flush sensation during injection (common side effect) Itching Mild, scattered hives 30 Systemic Reactions Moderate A true allergic reaction (anaphylactic reaction) Symptoms include the following: Urticaria (moderate to severe hives) Possible laryngeal swelling Bronchospasm Tachycardia ( 100 beats/min) Bradycardia ( 60 beats/min) Angioedema Hypotension 31 Systemic Reactions Severe (Vasovagal) Life-threatening reaction Symptoms include the following: Hypotension (systolic blood pressure 80 mm Hg) Bradycardia ( 50 beats/min) Cardiac arrhythmias Laryngeal swelling Possible convulsions Loss of consciousness Cardiac arrest Respiratory arrest No detectable pulse 32 6

7 Excretory Urography IVU Correct term Intravenous urogram (IVU): Radiographic examination of the urinary system Purposes of IVU 1. Visualize the collecting portion of the urinary system. 2. Assess the functional ability of the kidneys (a timed procedure). 34 Common Clinical Indications IVU 1. Abdominal or pelvic mass 2. Renal or urethral calculi 3. Kidney trauma 4. Flank pain 5. Hematuria 6. Hypertension 7. Renal failure 8. Urinary tract infection (UTI) (pyelonephritis) Renal calculi in right kidney 35 Patient Preparation for IVU* Light evening meal prior to procedure Bowel-cleansing laxative NPO after midnight (minimum of 8 hours) Enema on the morning of examination Voiding prior to procedure * Suggested protocol; prep may vary among departments and clinical needs 37 7

8 IVU Basic Routine Scout radiograph Injection Note time at beginning of injection Sample imaging routine 1 min nephrogram or nephrotomography (Hypertensive) 5 min AP supine min AP supine 20 min posterior obliques Postvoid (prone or erect) 38 Hypertensive IVU Purpose: IVU for patients with high blood pressure Suggested protocol: Radiographs taken every minute, up to 5 minutes After 5-minute IR, standard IVU routine Check with radiologist to determine additional images to be taken 39 Ureteric Compression Methods to enhance filling of pelvicalyceal system Trendelenburg Position CR at level of iliac crest, or Compression device medial to ASISs 40 8

9 Nephrotomogram and Nephrogram No rotation CR midway between xiphoid and iliac crest Three exposures taken (generally) 41 Nephrogram or Nephrotomogram Radiographs taken early in study to demonstrate renal parenchyma or functional portion of kidney Nephrotomogram 1 min Timing critical Nephrogram Single radiograph (1 min) Nephrotomogram Series of tomograms starting at 1 min 42 IVU Routine AP scout Nephrotomography (1 min following injection) AP RPO and LPO AP postvoid (recumbent or erect) Special AP ureteric compression 43 9

10 IVU AP Projection No rotation CR to level of iliac crest (include symphysis pubis) 44 Evaluation Criteria AP IVU Entire urinary system demonstrated No rotation No motion Appropriate technique employed Minute market visible 10-minute IVU 45 Evaluation Criteria AP with Ureteric Compression Upper urinary system demonstrated with enhanced pelvicalyceal and proximal ureteral filling No rotation No motion Appropriate technique employed 46 10

11 Evaluation Criteria Nephrotomography Entire renal parenchyma visualized No motion Appropriate technique employed Specific level markers visible Linear tomography 47 IVU Posterior Obliques CR at level of iliac crest 30 RPO 30 LPO 48 Evaluation Criteria Posterior Oblique Elevated side: Kidney is parallel to plane of IR Downside: Ureter is free of superimposition from spine Entire urinary system visualized No motion Appropriate technique employed Minute marker visible RPO 49 11

12 CR at level of iliac crest Include symphysis pubis AP (PA) Postvoid PA Prone AP Erect 50 Voiding Cystourethrography (VCUG) Technical Positioning Factors IR size: cm (10 12 in), lengthwise kv, grid CR perpendicular to symphysis pubis 52 Cystogram CR 2 inches (5 cm) superior to symphysis pubis AP: caudad Posterior oblique:

13 AP: urinary bladder not superimposed by pubic bones Posterior obliques: urinary bladder not superimposed by lower limbs Distal ureter, bladder, proximal urethra on male to be included Evaluation Criteria Cystogram 54 Voiding Cystourethrography Purpose: Functional study of the bladder and urethra Performed after routine cystogram Catheter removed and imaged while voiding Female AP Male 30 RPO 55 Retrograde Urography Performed in surgery Contrast media delivered retrograde through catheter 58 13

14 Retrograde Urography Procedure Scout radiograph taken Series of radiographs taken as requested Ureterogram taken once catheter has been removed 59 14